Severe open tibial fractures in combat trauma MANAGEMENT AND PRELIMINARY OUTCOMES

被引:41
作者
Penn-Barwell, J. G. [1 ]
Bennett, P. M.
Fries, C. A.
Kendrew, J. M.
Midwinter, M. J. [1 ]
Rickard, R. F.
机构
[1] Queen Elizabeth Med Ctr, Royal Ctr Def Med, Natl Inst Hlth Res, Surg Reconstruct Microbiol Res Ctr NIHR SRMRC, Birmingham B15 2TH, W Midlands, England
关键词
VASCULAR INJURY; RECONSTRUCTION; INFECTION; SALVAGE; WOUNDS; LEG;
D O I
10.1302/0301-620X.95B1.30580
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The aim of this study was to report the pattern of severe open diaphyseal tibial fractures sustained by military personnel, and their orthopaedic-plastic surgical management. The United Kingdom Military Trauma Registry was searched for all such fractures sustained between 2006 and 2010. Data were gathered on demographics, injury, management and preliminary outcome, with 49 patients with 57 severe open tibial fractures identified for in-depth study. The median total number of orthopaedic and plastic surgical procedures per limb was three (2 to 8). Follow-up for 12 months was complete in 52 tibiae (91%), and half the fractures (n = 26) either had united or in the opinion of the treating surgeon were progressing towards union. The relationship between healing without further intervention was examined for multiple variables. Neither the New Injury Severity Score, the method of internal fixation, the requirement for vascularised soft-tissue cover nor the degree of bone loss was associated with poor bony healing. Infection occurred in 12 of 52 tibiae (23%) and was associated with poor bony healing (p = 0.008). This series characterises the complex orthopaedic-plastic surgical management of severe open tibial fractures sustained in combat and defines the importance of aggressive prevention of infection.
引用
收藏
页码:101 / 105
页数:5
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